Provider Demographics
NPI:1184616062
Name:HAWORTH, BYRON A (DO)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:A
Last Name:HAWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2755
Mailing Address - Country:US
Mailing Address - Phone:301-724-7616
Mailing Address - Fax:301-724-4811
Practice Address - Street 1:500 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2755
Practice Address - Country:US
Practice Address - Phone:301-724-7616
Practice Address - Fax:301-724-4811
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH50243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD052890100Medicaid
WV0110279000Medicaid
PA1580845Medicaid
WV0110279000Medicaid